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This is VAERS ID 1034192

History of Changes from the VAERS Wayback Machine

First Appeared on 2/18/2021

VAERS ID: 1034192
VAERS Form:2
Age:74.0
Sex:Female
Location:Colorado
Vaccinated:2021-02-01
Onset:2021-02-03
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Death, Intestinal infarction, Intestinal ischaemia, Intraventricular haemorrhage, Cerebral small vessel ischaemic disease

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Fosamax, Cosopt soln, Emollient, Xalantan soln, Effient, Zocor
Current Illness: Glaucoma, HLD
Preexisting Conditions: Glaucoma, HLD
Allergies: none
Diagnostic Lab Data: Too numerous to include
CDC 'Split Type':

Write-up: Patient presented with spontaneous IVH of small vessel origin with essentially no past medical history. She then acutely developed mesenteric ischemia. Died due to all dead small bowel which also appeared to be small vessel disease and not embolic/thrombotic. This process started one week after


Changed on 5/7/2021

VAERS ID: 1034192 Before After
VAERS Form:2
Age:74.0
Sex:Female
Location:Colorado
Vaccinated:2021-02-01
Onset:2021-02-03
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Death, Intestinal infarction, Intestinal ischaemia, Intraventricular haemorrhage, Cerebral small vessel ischaemic disease

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Fosamax, Cosopt soln, Emollient, Xalantan soln, Effient, Zocor
Current Illness: Glaucoma, HLD
Preexisting Conditions: Glaucoma, HLD
Allergies: none none
Diagnostic Lab Data: Too numerous to include
CDC 'Split Type':

Write-up: Patient presented with spontaneous IVH of small vessel origin with essentially no past medical history. She then acutely developed mesenteric ischemia. Died due to all dead small bowel which also appeared to be small vessel disease and not embolic/thrombotic. This process started one week after


Changed on 5/14/2021

VAERS ID: 1034192 Before After
VAERS Form:2
Age:74.0
Sex:Female
Location:Colorado
Vaccinated:2021-02-01
Onset:2021-02-03
Submitted:0000-00-00
Entered:2021-02-16
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (MODERNA)) / MODERNA - / UNK - / -

Administered by: Other      Purchased by: ??
Symptoms: Death, Intestinal infarction, Intestinal ischaemia, Intraventricular haemorrhage, Cerebral small vessel ischaemic disease

Life Threatening? No
Birth Defect? No
Died? Yes
   Date died:2021-02-16
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 13     Extended hospital stay? No
Previous Vaccinations:
Other Medications: Fosamax, Cosopt soln, Emollient, Xalantan soln, Effient, Zocor
Current Illness: Glaucoma, HLD
Preexisting Conditions: Glaucoma, HLD
Allergies: none none
Diagnostic Lab Data: Too numerous to include
CDC 'Split Type':

Write-up: Patient presented with spontaneous IVH of small vessel origin with essentially no past medical history. She then acutely developed mesenteric ischemia. Died due to all dead small bowel which also appeared to be small vessel disease and not embolic/thrombotic. This process started one week after

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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1034192&WAYBACKHISTORY=ON


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